Regenerative Therapy in Erectile Dysfunction: A Survey on Current Global Practice Trends and GAF Expert Recommendations

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines. Materials and methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method. Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support. Conclusions: This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment

Endoscopic Ultrasound-Guided Gastroenterostomy versus Enteral Stenting for Malignant Gastric Outlet Obstruction: A Retrospective Propensity Score-Matched Study

Background: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen apposing metal stent has emerged as a minimally invasive treatment for the management of malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with enteral stenting (ES) for the treatment of mGOO. Methods: Patients who underwent EUS-GE or ES for mGOO between June 2017 and June 2023 at two Italian centers were retrospectively identified. The primary outcome was stent dysfunction. Secondary outcomes included technical success, clinical failure, safety, and hospital length of stay. A propensity score-matching analysis was performed using multiple covariates. Results: Overall, 198 patients were included (66 EUS-GE and 132 ES). The stent dysfunction rate was 3.1% and 16.9% following EUS-GE and ES, respectively (p = 0.004). Using propensity score-matching, 45 patients were allocated to each group. The technical success rate was 100% for both groups. Stent dysfunction was higher in the ES group compared with the EUS-GE group (20% versus 4.4%, respectively; p = 0.022) without differences in clinical efficacy (p = 0.266) and safety (p = 0.085). A significantly shorter hospital stay was associated with EUS-GE compared with ES (7.5 ± 4.9 days vs. 12.5 ± 13.0 days, respectively; p = 0.018). Kaplan-Meier analyses confirmed a higher stent dysfunction-free survival rate after EUS-GE compared with ES (log-rank test; p = 0.05). Conclusion: EUS-GE offers lower rates of stent dysfunction, longer stent patency, and shorter hospital stay compared with ES

Heavily treatment-experienced persons living with HIV currently in care in Italy: characteristics, risk factors, and therapeutic options-the ICONA Foundation cohort study

Objectives: Heavily treatment-experienced (HTE) people living with HIV (PLWH) pose unique challenges due to limited antiretroviral treatment (ART) options. Our study aimed to investigate the prevalence and features of HTE individuals followed up in the Italian Cohort Na & iuml;ve Antiretrovirals (ICONA) cohort as of December 31, 2021. Methods: HTE were defined based on meeting specific conditions concerning their current ART and their ART history up to December 31, 2021. Descriptive statistics were performed by HTE status. Regression analyses explored factors associated with becoming HTE based on pre-ART patients' characteristics. Cluster dendrogram analysis provided insights into subgroups with inadequate responses based on clusters of differentiation (CD4) counts and viral load (VL) trajectories. Results: Among the 8758 PLWH actively followed in our cohort, 163 individuals (1.9%), mainly female, younger, Italian, and infected through heterosexual contact, met the HTE criteria. A lower CD4 count at ART initiation (odds ratio [OR] 1.60 per 100 cells/mmc lower CD4, 95% confidence interval [CI] 1.06-2.41, P = 0.03) and hepatitis C virus antibody positivity (OR 1.90, 95% CI 1.16-3.11, P = 0.01) were associated with higher HTE risk. Thirty PLWH exhibited ongoing immune-virological failure (18% of the HTE subgroup and 0.003% of the total population). Thirty PLWH exhibited ongoing immune-virological failure (i.e., with a current CD4 count < 200 cells/mmc or VL > 200 copies/mL). A cluster analysis identified 13 (43%) with a current CD4 count < 200 cells/mmc. Also, notably, 19/30 (63%) had major acquired resistanceassociated mutations to at least one antiretroviral drug class. Conclusions: HTE is rare in our cohort and tends to co-exist with major resistance mutations. A focused investigation into treatment history and immuno-virological response is warranted, particularly given the availability of new antiretroviral drugs

Challenging Axillary Lymph Nodes on PET/CT in Cancer Patients throughout COVID-19 Vaccination Era

Background: The unexpected detection of axillary lymphadenopathy (AxL) in cancer patients (pts) represents a real concern during the COVID-19 vaccination era. Benign reactions may take place after vaccine inoculation, which can mislead image interpretation in patients undergoing F-18-FDG, F-18-Choline, and Ga-68-DOTATOC PET/CT. They may also mimic loco-regional metastases or disease. We assessed PET/CT findings after COVID-19 first dose vaccination in cancer patients and the impact on their disease course management. Methods: We evaluated 333 patients undergoing PET/CT (257 F-18-FDG, 54 F-18-Choline, and 23 Ga-68 DOTATOC) scans after the first vaccination with mRNA vaccine (Pfizer-BioNTech) (study group; SG). The uptake index (SUVmax) of suspected AxL was defined as significant when the ratio was > 1.5 as compared to the contralateral lymph nodes. Besides, co-registered CT (Co-CT) features of target lymph nodes were evaluated. Nodes with aggregate imaging positivity were further investigated. Results: Overall, the prevalence of apparently positive lymph nodes on PET scans was 17.1% during the vaccination period. 107 pts of the same setting, who had undergone PET/CT before the COVID-19 pandemic, represented the control group (CG). Only 3 patients of CG showed reactive lymph nodes with a prevalence of 2.8% (p < 0.001 as compared to the vaccination period). 84.2% of SG patients exhibited benign characteristics on co-CT images and only 9 pts needed thorough appraisal. Conclusion: The correct interpretation of images is crucial to avoid unnecessary treatments and invasive procedures in vaccinated cancer pts. A detailed anamnestic interview and the analysis of lymph nodes' CT characteristics, after performing PET/CT, may help to clear any misleading diagnosis. Clinical Trial Registration Number: Protocol # 20210053954/CEUR 118/2021

New perspectives on the role of cultural and environmental assets in the territorial socio-economic development processes. The Gargano National Park area

The present research aims to better understand the role of Cultural and Environmental Assets (CEAs) in the processes of socio-economic development of marginalised areas. The theoretical analysis starts from a brief review of the literature. Secondly, the research focuses on a particular marginalised area of the region of Puglia (South of Italy), namely the Gargano area, which is rich in natural resources and cultural traditions. Thirdly, reference is made to the latest technological perspectives in the field of the protection and promotion of CEAs. One of the major gaps of the current literature is the lack of models for development and management of CEAs providing an effective network between public and private systems based on a common regulation to all members of a territory. Also, a lack of geo- referencing by means of a Geographic Information System (GIS) on local scale with information widely shared by local actors is also present. To contribute to close the above gaps, the present study reflects on the criteria established for achieving the status of "integrated" cultural goods, and assesses how and which assets may be geo-referenced. The analysis of the state of the art highlights the need of ad-hoc policies for the implementation of geo-referencing systems as means to strengthen actual regulations that take into account development opportunities as well as more inclusive parameters adapted to the environmental context, and in line with the 2030 Agenda (UN), the Next Generation EU (NGEU) and the National Recovery and Resilience Plan (NRRP)

Bilateral renal hemorrhage in an anticoagulated patient: A rare case of Wunderlich syndrome

: We describe a rare case of Wunderlich syndrome with bilateral renal hemorrhage in a patient under anticoagulant therapy for atrial fibrillation. An 84-year-old woman came to our department complaining of acute bilateral flank pain. Clinical and laboratory examinations revealed a condition of hypovolemic shock. An abdominal contrast-enhanced CT scan detected the presence of a bilateral hemorrhage affecting the peri- and para-renal spaces. Planning an appropriate management strategy considering the anticoagulated treatment required a multidisciplinary approach in the case of the Wunderlich syndrome diagnosis

Educazione migrante tra passato, presente e futuro. Saggi in onore di Leonard Covello

Il volume riunisce i contributi di studiose e di studiosi italiani e americani per ricordare l'eccezionale figura di Leonard Covello pioniere delle strategie inclusive nella scuola statunitense e punto di riferimento per la vasta comunità di immigrati di East Harlem, tra gli anni Venti e Cinquanta del Novecento